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Case Study: Jasmin’s Journey

Jasmin’s* history

Jasmin is a young woman with a diagnosis of paranoid schizophrenia with comorbid ADHD. In her twenties, she was admitted to ten different psychiatric hospital in five years, several of these under Sections of the Mental Health Act.

Jasmin struggled with illicit substance misuse, had taken multiple overdoses, been recalled to hospital twice on a Community Treatment Order (CTO) and had experienced a breakdown of her supported living community placement.

In addition, she had experienced multiple relapses of her Schizophrenic illness due to a combination of illicit substance use, inconsistent engagement with staff and non-compliance with medication, partially a result of unwanted weight gain. Jasmin was on an Acute ward when she was referred to Cygnet Raglan House.

When Jasmin came to us

On admission, Jasmin was very unwell, she was hearing distressing auditory hallucinations throughout the day and was nursed on continuous observations due to her suicide attempts. Impulsivity secondary to her ADHD contributed to Jasmin’s suicide risk in addition to; distress incurred by her voices, hopelessness that she would ever be free of these symptoms and difficulty trusting and confiding in staff, about whom she harboured paranoid beliefs.

Jasmin needed support around her daily routine, self-care and interacting with others. She was unable to access the community due to her impulsivity and high-risk behaviour, and on previous escorted leave she had managed to run from staff onto busy roads without regard for herself or the oncoming traffic.

Jasmin’s care

The multi-disciplinary team (MDT) at Cygnet Raglan House worked together to produce a personalised care and treatment plan for Jasmin. The first few months remained difficult for her, however, the team persisted with a person-centred approach and responded to her changing needs.

The doctors commenced with an innovative pharmacotherapeutic approach informed by liaison with the senior pharmacist and current evidence-based findings. This involved utilising a co-produced plan with Jasmin to ensure the medication she was taking did not increase the risk of weight gain, which was a major concern for her, meaning Jasmin remained compliant with her medication.

The psychiatry team primarily focused on supporting Jasmin with her auditory hallucinations and over the coming months they started reducing, her mood stabilised and she began to build a relationship with the staff. The team offered assessments of presenting difficulties and need and worked with Jasmin on improving motivation, self-regulating and psychoeducation with interventions such as Cognitive Behavioural Therapy (CBT), Psychodynamic, Schema Therapy and Mentalization-based Therapy.

The occupational therapy department completed initial activity of daily living (ADL) assessments and supported Jasmin to increase her confidence and interactions in social sessions. Through developing rapport and building trust, Jasmin started to express an interest in childcare and wanting to improve her english and maths skills to facilitate this. The team arranged for Jasmin to attend sessions with a tutor and also attend a works programme to develop her routine, responsibilities and engagement.

As Jasmin progressed, the team worked with her on relapse prevention and future plans as she continued to attend her regular sessions. They looked at activities and employment she could access in the community to reduce the risk of relapse and co-produced a plan to support her reach her goals.

Jasmin today

Jasmin has made remarkable progress since arriving at Cygnet Raglan House, she is currently going out for unescorted leave, managing her finances independently and continues to work on her independence. Jasmin is able to seek support from staff in regulating her emotions and is able to communicate when she is feeling stressed or anxious and utilise her coping strategies. Jasmin has not experienced any hallucinations for many months.

Jasmin is currently working with the team on her discharge planning and hoping to move to her own accommodation in the future. Her family and the whole team are extremely pleased with her progress. Jasmin is looking forward to starting a college course this year in order to achieve her dream of working in care.

“Raglan House has really helped me. I was hearing voices constantly for 6 years and was really paranoid. Now after all those years, I am voice free. This is down to being put on suitable medication, psychology and a lot of different therapeutic groups – the staff are wonderful”

Download a copy of Jasmin’s Journey
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*Name has been changed to protect her identity

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